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Journal of Community Health

, Volume 42, Issue 3, pp 551–557 | Cite as

The Need for an Integrated Patient Navigation Pathway to Improve Access to Colonoscopy After Positive Fecal Immunochemical Testing: A Safety-Net Hospital Experience

  • Sreedevi Thamarasseril
  • Taft Bhuket
  • Chuck Chan
  • Benny Liu
  • Robert J. Wong
Original Paper
  • 188 Downloads

Abstract

Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States. Delays in access to colonoscopy following positive fecal immunochemical test (FIT) contribute to increased CRC incidence and mortality. To evaluate intervals from positive FIT result to receipt of colonoscopy among underserved safety-net populations. We retrospectively evaluated all average CRC risk adults who had positive FIT results from 2012 to 2015 at an ethnically diverse safety-net hospital system. Interval from positive FIT to receipt of colonoscopy was evaluated with Kaplan Meier methods and multivariate Cox proportional hazards models. Among 467 patients with positive FIT (48.4 % men, 39.5 % black, 22.5 % white, 17.4 % Asian, 9.7 % Hispanic, mean age 59.5 ± 9.8 years), mean time from positive FIT to receipt of colonoscopy was 220.5 days (SD 158.5). Compared to men, there was a trend towards longer time from FIT positive to colonoscopy among women (237.1 vs. 198.7 days, p = 0.07). No race/ethnicity-specific disparities in time to colonoscopy were observed. Compared to 2012–2013, there was a 27.2 % reduction in time from FIT positive to colonoscopy in 2014–2015 (173.9 vs. 238.8 days, p < 0.01). Among patients undergoing colonoscopy, 46.3 % had adenomatous polyps, 27.4 % had high risk adenomatous polyps, and 5.6 % had CRC. Among an ethnically diverse safety-net hospital system, improvements in access to colonoscopy after positive FIT were observed. However, patients still waited nearly 6 months from time of positive FIT to undergoing colonoscopy. Delays in receipt of colonoscopy are complex and reflect system-level and individual patient-level barriers.

Keywords

Access to care Colonoscopy Colon cancer Screening Safety-net 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors of this manuscript have no conflicts of interest to disclose.

References

  1. 1.
    Siegel, R. L., Miller, K. D., & Jemal, A. (2016). Cancer statistics, 2016. CA: A Cancer Journal for Clinicians, 66(1), 7–30. doi: 10.3322/caac.21332.Google Scholar
  2. 2.
    Amri R, Bordeianou LG, Sylla P, Berger DL. (2013). Impact of screening colonoscopy on outcomes in colon cancer surgery. JAMA Surgery, 148(8), 747–754. doi: 10.1001/jamasurg.2013.8.CrossRefPubMedGoogle Scholar
  3. 3.
    FORCE USPST, Bibbins-Domingo, K., Grossman, D. C., et al. (2016). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 315(23), 2564–2575. doi: 10.1001/jama.2016.5989.CrossRefGoogle Scholar
  4. 4.
    Knudsen AB, Zauber AG, Rutter CM, et al. (2016). Estimation of benefits, burden, and harms of colorectal cancer screening strategies: Modeling study for the US preventive services task force. JAMA, 315(23), 2595–2609. doi: 10.1001/jama.2016.6828.CrossRefPubMedGoogle Scholar
  5. 5.
    FORCE USPST (2008). Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 149(9), 627–637.CrossRefGoogle Scholar
  6. 6.
    Meester RG, Zauber AG, Doubeni CA, et al. (2016). Consequences of increasing time to colonoscopy examination following positive result from fecal colorectal cancer screening test. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association. doi: 10.1016/j.cgh.2016.05.017.Google Scholar
  7. 7.
    Chubak J, Garcia MP, Burnett-Hartman AN, et al. (2016). Time to colonoscopy after positive fecal blood test in four U.S. Health Care Systems. Cancer epidemiology, biomarkers & prevention: A publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 25(2), 344–350. doi: 10.1158/1055-9965.EPI-15-0470.Google Scholar
  8. 8.
    Gellad ZF, Almirall D, Provenzale D, Fisher DA. (2009). Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia. Digestive Diseases and Sciences, 54(11), 2497–2502. doi: 10.1007/s10620-008-0653-8.CrossRefPubMedGoogle Scholar
  9. 9.
    Oluloro A, Petrik AF, Turner A, et al. (2016). Timeliness of colonoscopy after abnormal fecal test results in a safety net practice. Journal of Community Health, 41(4):864–870. doi: 10.1007/s10900-016-0165-y.CrossRefPubMedGoogle Scholar
  10. 10.
    Millas, S. G., Alawadi, Z. M., Wray, C. J., et al. (2015). Treatment delays of colon cancer in a safety-net hospital system. The Journal of Surgical Research, 198(2), 311–316. doi: 10.1016/j.jss.2015.03.078.CrossRefPubMedGoogle Scholar
  11. 11.
    Lumpkins, C., Cupertino, P., Young, K., Daley, C., Yeh, H., & Greiner, K. (2013). Racial/ethnic variations in colorectal cancer screening self-efficacy, fatalism and risk perception in a safety-net clinic population: Implications for tailored interventions. Journal of Community Medicine & Health Education, 3.Google Scholar
  12. 12.
    Jerant, A. F., Fenton, J. J., & Franks, P. (2008). Determinants of racial/ethnic colorectal cancer screening disparities. Archives of Internal Medicine, 168(12), 1317–1324. doi: 10.1001/archinte.168.12.1317.CrossRefPubMedGoogle Scholar
  13. 13.
    Correia A, Rabeneck L, Baxter NN, et al. (2015). Lack of follow-up colonoscopy after positive FOBT in an organized colorectal cancer screening program is associated with modifiable health care practices. Preventive Medicine, 76, 115–122. doi: 10.1016/j.ypmed.2015.03.028.CrossRefPubMedGoogle Scholar
  14. 14.
    Etzioni, D. A., Yano, E. M., Rubenstein, L. V., et al. (2006). Measuring the quality of colorectal cancer screening: The importance of follow-up. Diseases of the Colon and Rectum, 49(7), 1002–1010. doi: 10.1007/s10350-006-0533-2.CrossRefPubMedGoogle Scholar
  15. 15.
    Powell, A. A., Gravely, A. A., Ordin, D. L., Schlosser, J. E., & Partin, M. R. (2009). Timely follow-up of positive fecal occult blood tests strategies associated with improvement. American Journal of Preventive Medicine, 37(2), 87–93. doi: 10.1016/j.amepre.2009.05.013.CrossRefPubMedGoogle Scholar
  16. 16.
    Ferrat, E., Le Breton, J., Veerabudun, K., et al. (2013). Colorectal cancer screening: Factors associated with colonoscopy after a positive faecal occult blood test. British Journal of Cancer, 109(6), 1437–1444. doi: 10.1038/bjc.2013.476.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gupta S, Halm EA, Rockey DC, et al. (2013). Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: A randomized clinical trial. JAMA Internal Medicine, 173(18), 1725–1732. doi: 10.1001/jamainternmed.2013.9294.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Humphrey, L. L., Shannon, J., Partin, M. R., O’Malley, J., Chen, Z., & Helfand, M. (2011). Improving the follow-up of positive hemoccult screening tests: An electronic intervention. Journal of General Internal Medicine, 26(7), 691–697. doi: 10.1007/s11606-011-1639-3.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Powell, A. A., Nugent, S., Ordin, D. L., Noorbaloochi, S., & Partin, M. R. (2011). Evaluation of a VHA collaborative to improve follow-up after a positive colorectal cancer screening test. Medical Care, 49(10), 897–903. doi: 10.1097/MLR.0b013e3182204944.CrossRefPubMedGoogle Scholar
  20. 20.
    Singh H, Kadiyala H, Bhagwath G, et al. (2009). Using a multifaceted approach to improve the follow-up of positive fecal occult blood test results. The American Journal of Gastroenterology, 104(4), 942–952. doi: 10.1038/ajg.2009.55.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Stock, D., Rabeneck, L., Baxter, N. N., et al. (2015). Mailed participant reminders are associated with improved colonoscopy uptake after a positive FOBT result in Ontario’s ColonCancerCheck program. Implementation Science: IS, 10, 35. doi: 10.1186/s13012-015-0226-0.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sreedevi Thamarasseril
    • 1
  • Taft Bhuket
    • 1
  • Chuck Chan
    • 1
  • Benny Liu
    • 1
  • Robert J. Wong
    • 1
  1. 1.Department of Medicine, Division of Gastroenterology and HepatologyAlameda Health System – Highland HospitalOaklandUSA

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